Aim: Non neutropenic fevers (NNF) is an emerging issue which carries significant morbidity and health care related costs. The lack of a validated discharge assessment tool often results in prolonged hospital admission, over investigations and exposure to healthcare associated infections. This retrospective review aims to compare the outcomes of NNF treated in an outpatient versus inpatient setting in a regional centre. This review is relevant during this unprecedented COVID-19 pandemic as we strive for early discharges.
Methods: This is a single-centre, retrospective study performed at the Townsville Cancer Centre. Patients who received chemotherapy between January 2017 until January 2020 for any non-haematological solid organ malignancy with absolute neutrophil count (ANC) of 0.5 and greater and stable haemodynamic parameters were included. Chemotherapy had to be given within 30 days of presentation with a documented fever.
Results: 83 patients were included; 78 had ANC >1.0 and 5 had ANC 0.5-1.0. Bacteraemia was identified in two patients (2.4%) and overall mortality rate was zero. 65 patients were admitted and 18 were discharged from ED.
Re-presentation with NNF was 4/18 (22.2%) in patients discharged from ED. Two were safely discharged from ED with outpatient follow up. 61/65 (93.8%) patients admitted received intravenous antibiotics for an average of 1.5 days. Only one developed severe neutropenia during admission with an ANC less than 0.5. Factors such as concurrent chemoradiation, prophylactic antibiotics, type of chemotherapy and liver metastases were not associated with hospital presentation.
Conclusion: NNF patients discharged from ED had low rates of readmission, bacteraemia and zero mortality. A larger sample size is required to identify any associating factors. However, it seems that patients can be safely discharged and managed in an outpatient setting. Guidelines need to be developed through larger studies as to whether antibiotics would be necessary at all in this subset.